Part II. The CCT in. Intensive Care Medicine. Assessment System. The Faculty of. Intensive Care Medicine

Part II The CCT in Intensive Care Medicine Assessment System The Faculty of Intensive Care Medicine

Contents 1. Principles of Assessment... 3 1.1 Training Stage Records... 3 1.2 How many workplace-based assessments?... 3 1.3 Additional Assessments... 4 2. Competency level descriptors... 5 3. ICM CCT Training Progression Grid... 6 Training Record Forms Stage 1 Training Record... 10 Stage 2 Training Record... 15 Stage 3 Training Record... 20 Special Skills Year Completion Form... 25 4. ARCP decision aids... 26 4.1 Core Training... 26 4.2 Dual CCTs training... 26 4.3 ICM Higher Specialist Training... 26 4.4 Training Requirement Checklists... 29 4.4.1 Stage 1... 29 4.4.2 Stage 2... 29 4.4.3 Stage 3... 30 5. Top 30 cases... 31 6. Blueprint of Workplace-based Assessments mapped against curriculum competencies... 35 7. Blueprint of Final FFICM examination mapped against curriculum competencies... 39 II - 2

1. Principles of Assessment This Assessment System should be read in tandem with and implemented as per the precepts of Part I, section 5 of this curriculum manual. The ICM CCT has an assessment system that in some ways differs from that used in some of its partner specialties. Anaesthetic assessment for example, samples from its curriculum and has an indicative minimum number of workplace-based assessments (WPBA) in each training module. The ICM CCT requires trainees to demonstrate increasing competency in all domains of the curriculum and each of its 97 competencies. Sub-domain competence progression is judged on a descriptive scale of 1 to 4 (novice to independent practitioner see section 2 below); competencies are revisited throughout each of the three ICM Stages of training with increasing target levels of achievement. 1.1 Training Stage Records This manual contains Training Records for each of the three Stages of ICM training. They are designed to provide outcome paperwork enabling trainees to demonstrate their acquisition of competencies against the levels required by Training Progression Grid. Trainees using the ICM eportfolio will find that it already serves this function, and so do not need to use the enclosed Training Records. However it is recognised that not all ICM trainees will immediately be using eportfolio for example, trainees who are halfway through a Stage of training may maintain a paper-based portfolio until they have completed that Stage before moving to the electronic system. These Training Records are also available separately on the FICM website (www.ficm.ac.uk) in editable Word format. 1.2 How many workplace-based assessments? The purpose of the ICM WPBAs is not merely to tick off each individual competence but to provide a series of snapshots of work, from the general features of which it can be inferred whether the trainee is making the necessary progress, not only in the specific work observed, but in related areas of the application of knowledge and skill. The number of observations of work required will not be fixed but will depend on the individual trainee s performance. The Faculty s aim is always to maintain training standards and quality without developing undue assessment burden for trainers and trainees. As a minimum standard, trainees must have at least one piece of satisfactory assessment evidence for every competency required for sign-off at a particular Stage of training, though it is expected that trainees will ultimately have multiple assessment mapping to multiple competencies. Some sections of the curriculum (i.e. Practical Procedures) it is expected that more will be required, at the discretion of local trainers. Where a trainee performs unsatisfactorily more assessments will of course be needed. Each piece of evidence can potentially be used to support multiple competencies. A single patient encounter involving a history, examination, differential diagnosis and construction and implementation of a management plan could assess many of the competencies together. For example, a trainee may see a patient in the acute admission unit, assess them, start investigations, diagnose their pneumonia, start the patient on antibiotics and bring them to the ICU where they may need respiratory support. In such a scenario the trainee can, via the use of CBD, DOPS or CEX, bundle together assessment of competencies such as: 1.1 2.1 2.2 2.5 Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology; Obtains a history and performs an accurate clinical examination; Undertakes timely and appropriate investigations; Obtains and interprets the results of blood gas samples; II - 3

3.1 4.2 5.1 5.8 Manages the care of the critically ill patient with specific acute medical conditions; Manages antimicrobial drug therapy; Administers oxygen using a variety of administration devices; Performs arterial catheterisation It is the responsibility of the trainee to provide sufficient evidence of satisfactory performance and satisfactory progress in their annual review. They will need evidence of performance in each block of training or section of the curriculum they have undertaken. This may increase the number of assessments they need. It is the Educational Supervisor s responsibility to help the trainee to understand what that evidence will be in their specific circumstances. The Educational Supervisor will then write a summary of the learner s performance for the ARCP. Once again it must be stressed that there is no single, valid, reliable test of competence and the ARCP will review all the evidence, triangulating performance measured by different instruments, before drawing conclusions about a trainee s progress. 1.2.1 Repetition of competencies It is recognised that due to the spiral learning principles (see 3.1.1) upon which the curriculum was constructed, competencies reoccur throughout all three Stages of training. In some cases, i.e. if the competency in question is a very basic one, trainees will reach level 4 very quickly (conversely whilst in some highly specialised areas such as Paediatric Intensive Care Medicine they will never reach level 4 at all). As such there are numerous cases where the expected 1-4 training level for a particular competence does not change from one Stage to the next these are clearly marked on the individual Stage Training Records below. In these instances to avoid the aforementioned assessment burden Educational Supervisors must still sign-off each competency but trainees need not provide additional WPBA or assessment evidence if they have demonstrated maintenance of their skills and knowledge in these specific competencies. Additional assessments in these competencies may be conducted if required, at the trainers discretion, if it is felt that the trainees maintenance of these competencies is uncertain or requires topping up. 1.3 Additional Assessments It is also recognised that trainees may use other methods than WPBAs to demonstrate their acquisition of competencies, such as logbook evidence and attendance at educational events. These can be recorded in the trainee s portfolio (a code system is provided on each Stage record; on eportfolio these can be scanned, uploaded, and assigned to the relevant curriculum competencies). II - 4

2. Competency level descriptors Both trainees and trainers need to ensure that training is both comprehensive and that progression of training is occurring at a satisfactory rate. The curriculum uses a Training Progression Grid, which includes the CoBaTrICE domains, to both define and measure progress. This is combined with a simple and intuitive measure of level of competence which uses the intensity of supervision required to identify achievement. The level descriptors are as follows: Task orientated Level competence 1 Performs task under direct supervision. 2 Performs task in straightforward circumstances, requires help for more difficult situations. Understands indications and complications of task. 3 Performs task in most circumstances, will need some guidance in complex situations. Can manage most complications, has a good understanding of contraindications and alternatives. 4 Independent (consultant) practice. Knowledge orientated competence Very limited knowledge; requires considerable guidance to solve a problem within the area. Sound basic knowledge; requires some guidance to solve a problem within the area. Will have knowledge of appropriate guidelines and protocols. Advanced knowledge and understanding; only requires occasional advice and assistance to solve a problem. Will be able to assess evidence critically. Expert level of knowledge. Patient management competence Can take history, examine and arrange investigations for straight forward case (limited differential diagnosis). Can initiate emergency management and continue a management plan, recognising acute divergences from the plan. Will need help to deal with these. Can take history, examine and arrange investigations in a more complicated case. Can initiate emergency management. In a straightforward case, can plan management and manage any divergences in short term. Will need help with more complicated cases. Can take history, examine and arrange investigations in a more complex case in a focused manner. Can initiate emergency management. In a most cases, can plan management and manage any divergences. May need specialist help for some cases. Specialist. By the completion of the ICM training programme all trainees will be expected to have achieved level 4 competency in the majority of the CoBaTrICE competences, as detailed on the grid. In order to provide both a measure of progress to trainees and trainers and also to provide an indication of where in the training programme individual competencies are best achieved we have produced an ARCP decision aid. This provides ARCP panels with guidance about the progress and evidence of progress expected for individual trainees. II - 5

3. ICM CCT Training Progression Grid The following grid demonstrates the progression of competency expected of trainees in each curriculum domain throughout the Stages of ICM training. The grid acknowledges that trainees will reach Level 4 in some fundamental competencies earlier in their training (e.g. infection control, aspects of professionalism), and will not reach Level 4 in some highly specialised areas of intensive care (e.g. Paediatric Intensive Care Medicine, burns). Domain and Competencies Stage of Training Stage 1 Domain 1: Resuscitation and management of the acutely ill patient ACCS CAT CMT ST Stage 2 Stage 3 1.1 Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology 2 1 2 3 4 4 1.2 Manages cardiopulmonary resuscitation - ALS recommended 3 3 3 3 4 4 1.3 Manages the patient post resuscitation 1 1 1 2 4 4 1.4 Triages and prioritises patients appropriately, including timely admission to ICU 1 1 1 2 3 4 1.5 Assesses and provides initial management of the trauma patient 1 1 0 2 3 4 1.6 Assesses and provides initial management of the patient with burns 0 0 0 1 2 3 1.7 Describes the management of mass casualties 1 0 0 1 2 3 Domain 2: Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation ACCS CAT CMT ST Stage 2 Stage 3 2.1 Obtains a history and performs an accurate clinical examination 2 1 2 3 4 4 2.2 Undertakes timely and appropriate investigations 2 1 2 3 3 4 2.3 Performs electrocardiography (ECG / EKG) and interprets the results 2 2 2 3 4 4 2.4 Obtains appropriate microbiological samples and interprets results 2 1 2 3 4 4 2.5 Obtains and interprets the results from blood gas samples 2 2 2 3 4 4 2.6 Interprets imaging studies 2 1 2 3 4 4 2.7 Monitors and responds to trends in physiological variables 2 2 1 3 4 4 2.8 Integrates clinical findings with laboratory investigations to form a differential diagnosis 1 1 2 2 3 4 Domain 3: Disease Management ACCS CAT CMT ST Stage 2 Stage3 3.1 Manages the care of the critically ill patient with specific acute medical conditions 1 1 1 2 3 4 3.2 Identifies the implications of chronic and co-morbid disease in the acutely ill patient 1 1 2 2 3 4 3.3 Recognises and manages the patient with circulatory failure 1 1 1 2 3 4 3.4 Recognises and manages the patient with, or at risk of, acute renal failure 1 1 1 2 3 4 3.5 Recognises and manages the patient with, or at risk of, acute liver failure 1 1 1 2 3 4 3.6 Recognises and manages the patient with neurological impairment 1 1 1 2 3 4 3.7 Recognises and manages the patient with acute gastrointestinal failure 1 1 1 2 3 4 3.8 Recognises and manages the patient with severe acute respiratory failure / acute lung injury syndromes (ALI / ARDS) 0 0 0 2 3 4 3.9 Recognises and manages the septic patient 1 1 1 2 3 4 II - 6

3.10 Recognises and manages the patient following intoxication with drugs or environmental toxins 1 1 1 2 3 4 3.11 Recognises life-threatening maternal peripartum complications and manages care 1 1 1 2 3 4 Domain 4: Therapeutic interventions / Organ support in single or multiple organ failure ACCS CAT CMT ST Stage 2 Stage3 4. 1 Prescribes drugs and therapies safely 2 2 2 3 3 4 4.2 Manages antimicrobial drug therapy 2 2 2 3 3 4 4.3 Administers blood and blood products safely 2 2 1 3 4 4 4.4 Uses fluids and vasoactive / inotropic drugs to support the circulation 2 2 1 3 4 4 4.5 Describes the use of mechanical assist devices to support the circulation 0 0 0 1 2 3 4.6 Initiates, manages, and weans patients from invasive and non-invasive ventilatory support 1 1 0 2 4 4 4.7 Initiates, manages and weans patients from renal replacement therapy 0 0 0 2 3 4 4.8 Recognises and manages electrolyte, glucose and acid-base disturbances 1 1 1 3 4 4 4.9 Co-ordinates and provides nutritional assessment and support 2 2 2 3 4 4 Domain 5: Practical procedures ACCS CAT CMT ST Stage 2 Stage 3 5.1 Administers oxygen using a variety of administration devices 2 2 2 3 4 4 5.2 Performs emergency airway management 1 2 0 2 3 4 5.3 Performs difficult and failed airway management according to local protocols 0 2 0 2 2 3 5.4 Performs endotracheal suction 2 2 0 3 4 4 5.5 Performs fibreoptic bronchoscopy and BAL in the intubated patient 0 0 0 2 3 4 5.6 Performs percutaneous tracheostomy 0 0 0 1 3 4 5.7 Performs chest drain insertion 2 1 2 2 3 4 5.8 Performs arterial catheterisation 1 1 0 3 4 4 5.9 Performs ultrasound techniques for vascular localisation 1 1 0 2 4 4 5.10 Performs central venous catheterisation 1 1 0 2 4 4 5.11 Performs defibrillation and cardioversion 2 2 2 3 4 4 5.12 Performs transthoracic cardiac pacing, describes transvenous 0 0 0 2 3 4 5.13 Describes how to perform pericardiocentesis 1 1 1 1 2 3 5.14 Demonstrates a method for measuring cardiac output and derived haemodynamic variables 1 1 2 3 4 4 5.15 Performs lumbar puncture (intradural / 'spinal') under supervision 2 2 1 3 4 4 5.16 Manages the administration of analgesia via an epidural catheter 1 1 0 3 4 4 5.17 Performs abdominal paracentesis 0 0 0 1 2 3 5.18 Describes Sengstaken tube (or equivalent) placement 1 1 1 2 2 3 5.19 Performs nasogastric tube placement 3 3 3 4 4 4 5.20 Performs urinary catheterisation 3 3 3 4 4 4 Domain 6: Perioperative care ACCS CAT CMT ST Stage2 Stage3 6.1 Manages the pre- and post-operative care of the high risk surgical patient 0 1 0 2 4 4 6.2 Manages the care of the patient following cardiac surgery 0 0 0 1 3 3 6.3 Manages the care of the patient following craniotomy 0 0 0 1 3 3 II - 7

6.4 Manages the care of the patient following solid organ transplantation 0 0 0 1 3 3 6.5 Manages the pre- and post-operative care of the trauma patient under supervision 1 1 0 2 3 4 Domain 7: Comfort and recovery ACCS CAT CMT ST Stage 2 Stage 3 7.1 Identifies and attempts to minimise the physical and psychosocial consequences of critical illness for patients and families 1 1 1 3 4 4 7.2 Manages the assessment, prevention and treatment of pain and delerium 2 2 2 3 4 4 7.3 Manages sedation and neuromuscular blockade 2 2 0 2 4 4 7.4 Communicates the continuing care requirements, including rehabilitation, of patients at ICU discharge to health care professionals, patients and relatives 1 1 0 3 4 4 7.5 Manages the safe and timely discharge of patients from the ICU 1 1 1 2 3 4 Domain 8: End of life care ACCS CAT CMT ST Stage 2 Stage 3 8.1 Manages the process of withholding or withdrawing treatment with the multi-disciplinary team 1 1 1 2 3 4 8.2 Discusses end of life care with patients and their families / surrogates 1 1 1 2 3 4 8.3 Manages palliative care of the critically ill patient 0 0 0 2 4 4 8.4 Performs brain-stem death testing 0 0 0 1 4 4 8.5 Manages the physiological support of the organ donor 0 0 0 1 3 4 8.6 Manages donation following cardiac death 0 0 0 1 3 4 Domain 9: Paediatric care ACCS CAT CMT ST Stage 2 Stage 3 9.1 Describes the recognition of the acutely ill child and initial management of paediatric emergencies 0 0 0 1 3 3 9.2 Describes national legislation and guidelines relating to child protection and their relevance to critical care 1 1 1 3 3 3 Domain 10: Transport ACCS CAT CMT ST Stage 2 Stage 3 10.1 Undertakes transport of the mechanically ventilated critically ill patient outside the ICU 1 1 0 2 4 4 Domain 11: Patient safety and health systems management ACCS CAT CMT ST Stage 2 Stage 3 11.1 Leads a daily multidisciplinary ward round 1 0 2 2 3 4 11.2 Complies with local infection control measures 3 3 3 3 4 4 11.3 Identifies environmental hazards and promotes safety for patients and staff 2 2 2 3 4 4 11.4 Identifies and minimises risk of critical incidents and adverse events, including complications of critical illness 1 1 1 2 3 4 11.5 Organises a case conference 0 0 0 2 3 4 11.6 Critically appraises and applies guidelines, protocols and care bundles 2 2 2 2 3 4 11.7 Describes commonly used scoring systems for assessment of severity of illness, case mix and workload 1 1 1 3 4 4 11.8 Demonstrates an understanding of the managerial and administrative responsibilities of the ICM specialist 0 0 0 2 3 4 Domain 12: Professionalism ACCS CAT CMT ST Stage 2 Stage 3 12.1 Communicates effectively with patients and relatives 2 2 2 3 4 4 II - 8

12.2 Communicates effectively with members of the health care team 2 2 2 3 4 4 12.3 Maintains accurate and legible records / documentation 2 2 2 4 4 4 12.4 Involves patients (or their surrogates if applicable) in decisions about care and treatment 1 1 1 3 4 4 12.5 Demonstrates respect of cultural and religious beliefs and an awareness of their impact on decision making 2 2 2 4 4 4 12.6 Respects privacy, dignity, confidentiality and legal constraints on the use of patient data 2 2 2 4 4 4 12.7 Collaborates and consults; promotes team-working 2 2 2 3 4 4 12.8 Ensures continuity of care through effective hand-over of clinical information 2 2 2 4 4 4 12.9 Supports clinical staff outside the ICU to enable the delivery of effective care 2 2 2 3 4 4 12.10 Appropriately supervises, and delegates to others, the delivery of patient care 1 1 1 2 3 4 12.11 Takes responsibility for safe patient care 2 2 2 4 4 4 12.12 Formulates clinical decisions with respect for ethical and legal principles 1 1 1 2 3 4 12.13 Seeks learning opportunities and integrates new knowledge into clinical practice 2 2 2 4 4 4 12.14 Participates in multidisciplinary teaching 3 3 3 4 4 4 12.15 Participates in research or audit under supervision 2 2 2 3 4 4 II - 9

INTENSIVE CARE MEDICINE STAGE 1 TRAINING RECORD Name of Trainee: Hospital(s): GMC Number: Date of Stage 1 ST entry: (DD/MM/YYYY) Core programme completed: ACCS CAT CMT Instructions Number each assessment in your portfolio (e.g. for DOPS D1, D2 etc). Complete the table columns Trainee Evidence by identifying in the relevant item(s) of evidence in your portfolio by its code (D1, D2 etc). At least 1 piece of suitable evidence is required for each of the relevant competencies. One assessment can be used to cover multiple curriculum competencies. The WPBA column describes what type of workplacebased assessment is suitable for each competency, as defined by The CCT in Intensive Care Medicine. Other types of evidence may be used to demonstrate competencies, as described in Additional Assessment Tools Key below. Competencies may be signed off by Educational Supervisors throughout the training Stage. Please ensure that the numbering of evidence items in this table matches that in your portfolio. Stage 1 Target Level indicates the final competency level for this Stage of training. Trainees should not normally be marked higher than these levels at the end of the Stage unless in exceptional circumstances with accompanying evidence. Entry Level indicates the level at which the trainee entered the particular training year as dictated by the Core programme they have completed. Please see the full Syllabus for details of the knowledge, skills and behaviours which make up each competency. Achievement Levels for some competencies may not change between training grades these have been highlighted. In these instances Educational Supervisors must still sign-off each competency but trainees need not provide additional WPBA or assessment evidence if they have demonstrated maintenance of their skills and knowledge in these specific competencies. Additional assessments in these competencies may be conducted if required, at the trainers discretion. Competency Level Descriptors Level Task orientated competence Knowledge orientated competence Patient management competence 1 Performs task under direct supervision. 2 3 Performs task in straightforward circumstances, requires help for more difficult situations. Understands indications and complications of task. Performs task in most circumstances, will need some guidance in complex situations. Can manage most complications, has a good understanding of contraindications and alternatives. Very limited knowledge; requires considerable guidance to solve a problem within the area. Sound basic knowledge; requires some guidance to solve a problem within the area. Will have knowledge of appropriate guidelines and protocols. Advanced knowledge and understanding; only requires occasional advice and assistance to solve a problem. Will be able to assess evidence critically. 4 Independent (consultant) practice. Expert level of knowledge. Specialist. Can take history, examine and arrange investigations for straight forward case (limited differential diagnosis). Can initiate emergency management and continue a management plan, recognising acute divergences from the plan. Will need help to deal with these. Can take history, examine and arrange investigations in a more complicated case. Can initiate emergency management. In a straightforward case, can plan management and manage any divergences in short term. Will need help with more complicated cases. Can take history, examine and arrange investigations in a more complex case in a focused manner. Can initiate emergency management. In a most cases, can plan management and manage any divergences. May need specialist help for some cases. Workplace-Based Assessment Tools Key D Direct Observation of Procedural Skills [DOPS] C Case-Based Discussion [CBD] T Acute Care Assessment Tool [ACAT] I ICM Mini-Clinical Evaluation Exercise [I-CEX] M Multi-source Feedback [MSF] S Simulation Additional Assessment Tools Key - These can be used in Trainee Evidence as appropriate for the competency being assessed L Anaesthetic List Management Tool [ALMAT] EE Educational Event G Logbook page [include page ref, i.e. G22] II - 10

Domain and Competencies Entry Levels Stage 1 Level Assessment Trainee Educational Supervisor Target ACCS CAT CMT Achieved Tools Evidence Level Sign-off Date Domain 1: Resuscitation and management of the acutely ill patient 1.1 Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology 2 1 2 3 I, C, M, T, S 1.2 Manages cardiopulmonary resuscitation ALS recommended 3 3 3 3 I, M, T, S 1.3 Manages the patient post resuscitation 1 1 1 2 I, M, T, S 1.4 Triages and prioritises patients appropriately, including timely admission to ICU 1 1 1 2 C, M, T 1.5 Assesses and provides initial management of the trauma patient 1 1 0 2 D, I, M, T, C, S 1.6 Assesses and provides initial management of the patient with burns 0 0 0 1 D, I, M, T, C 1.7 Describes the management of mass casualties 1 0 0 1 C Domain 2: Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation 2.1 Obtains a history and performs an accurate clinical examination 2 1 2 3 I, M 2.2 Undertakes timely and appropriate investigations 2 1 2 3 I, C, M 2.3 Performs electrocardiography (ECG / EKG) and interprets the results 2 2 2 3 D, I, C 2.4 Obtains appropriate microbiological samples and interprets results 2 1 2 3 D, C 2.5 Obtains and interprets the results from blood gas samples 2 2 2 3 D, C 2.6 Interprets imaging studies 2 1 2 3 I, C 2.7 Monitors and responds to trends in physiological variables 2 2 1 3 I, T, S 2.8 Integrates clinical findings with laboratory investigations to form a differential diagnosis 1 1 2 2 I, C, T, S Domain 3: Disease Management 3.1 Manages the care of the critically ill patient with specific acute medical conditions 1 1 1 2 D, I, C, M, T, S 3.2 Identifies the implications of chronic and co-morbid disease in the acutely ill patient 1 1 2 2 C 3.3 Recognises and manages the patient with circulatory failure 1 1 1 2 I, C, T, S 3.4 Recognises and manages the patient with, or at risk of, acute renal failure 1 1 1 2 I, C, T 3.5 Recognises and manages the patient with, or at risk of, acute liver failure 1 1 1 2 I, C, T 3.6 Recognises and manages the patient with neurological impairment 1 1 1 2 I, C, T, S 3.7 Recognises and manages the patient with acute gastrointestinal failure 1 1 1 2 I, C, T 3.8 Recognises and manages the patient with severe acute respiratory failure / acute lung injury syndromes (ALI / ARDS) 0 0 0 2 I, C, T 3.9 Recognises and manages the septic patient 1 1 1 2 I, C, T 3.10 Recognises and manages the patient following intoxication with drugs or environmental toxins 1 1 1 2 I, C, S 3.11 Recognises life-threatening maternal peripartum complications and manages care 1 1 1 2 I, C, S Domain 4: Therapeutic interventions / Organ support in single or multiple organ failure 4. 1 Prescribes drugs and therapies safely 2 2 2 3 D, C, M 4.2 Manages antimicrobial drug therapy 2 2 2 3 I, C, M 4.3 Administers blood and blood products safely 2 2 1 3 D, C, M 4.4 Uses fluids and vasoactive / inotropic drugs to support the circulation 2 2 1 3 I, C 4.5 Describes the use of mechanical assist devices to support the circulation 0 0 0 1 C II - 11

4.6 Initiates, manages, and weans patients from invasive and non-invasive ventilatory support 1 1 0 2 D, C, T 4.7 Initiates, manages and weans patients from renal replacement therapy 0 0 0 2 D, I, C, T 4.8 Recognises and manages electrolyte, glucose and acid-base disturbances 1 1 1 3 I, C, T, S 4.9 Co-ordinates and provides nutritional assessment and support 2 2 2 3 I, C, T Domain 5: Practical procedures 5.1 Administers oxygen using a variety of administration devices 2 2 2 3 D, S 5.2 Performs emergency airway management 1 2 0 2 D, S 5.3 Performs difficult and failed airway management according to local protocols 0 2 0 2 D, S 5.4 Performs endotracheal suction 2 2 0 3 D 5.5 Performs fibreoptic bronchoscopy and BAL in the intubated patient 0 0 0 2 D, M 5.6 Performs percutaneous tracheostomy 0 0 0 1 D, M, S 5.7 Performs chest drain insertion 2 1 2 2 D 5.8 Performs arterial catheterisation 1 1 0 3 D, C 5.9 Performs ultrasound techniques for vascular localisation 1 1 0 2 C 5.10 Performs central venous catheterisation 1 1 0 2 D, C 5.11 Performs defibrillation and cardioversion 2 2 2 3 D, C, S 5.12 Performs transthoracic cardiac pacing, describes transvenous 0 0 0 2 D, C 5.13 Describes how to perform pericardiocentesis 1 1 1 1 C 5.14 Demonstrates a method for measuring cardiac output and derived haemodynamic variables 1 1 2 3 D, C 5.15 Performs lumbar puncture (intradural / 'spinal') under supervision 2 2 1 3 D, S 5.16 Manages the administration of analgesia via an epidural catheter 1 1 0 3 I 5.17 Performs abdominal paracentesis 0 0 0 1 D 5.18 Describes Sengstaken tube (or equivalent) placement 1 1 1 2 C 5.19 Performs nasogastric tube placement 3 3 3 4 D 5.20 Performs urinary catheterisation 3 3 3 4 D Domain 6: Perioperative care 6.1 Manages the pre- and post-operative care of the high risk surgical patient 0 1 0 2 C, M, T 6.2 Manages the care of the patient following cardiac surgery 0 0 0 1 C 6.3 Manages the care of the patient following craniotomy 0 0 0 1 C, T 6.4 Manages the care of the patient following solid organ transplantation 0 0 0 1 C 6.5 Manages the pre- and post-operative care of the trauma patient under supervision 1 1 0 2 C. T Domain 7: Comfort and recovery 7.1 Identifies and attempts to minimise the physical and psychosocial consequences of critical illness for patients and families 1 1 1 3 M, C 7.2 Manages the assessment, prevention and treatment of pain and delirium 2 2 2 3 D, I, C, M, T 7.3 Manages sedation and neuromuscular blockade 2 2 0 2 D, I, C, M, T 7.4 Communicates the continuing care requirements, including rehabilitation, of patients at ICU discharge to health care professionals, patients and relatives 1 1 0 3 M, T, S 7.5 Manages the safe and timely discharge of patients from the ICU 1 1 1 2 M, T Domain 8: End of life care II - 12

8.1 Manages the process of withholding or withdrawing treatment with the multidisciplinary team 1 1 1 2 C, M 8.2 Discusses end of life care with patients and their families / surrogates 1 1 1 2 C, M, D 8.3 Manages palliative care of the critically ill patient 0 0 0 2 C, M, T 8.4 Performs brain-stem death testing 0 0 0 1 D, S 8.5 Manages the physiological support of the organ donor 0 0 0 1 I, C 8.6 Manages donation following cardiac death 0 0 0 1 C, T, S Domain 9: Paediatric care 9.1 Describes the recognition of the acutely ill child and initial management of paediatric emergencies 0 0 0 1 I, C, S 9.2 Describes national legislation and guidelines relating to child protection and their relevance to critical care 1 1 1 3 C Domain 10: Transport 10.1 Undertakes transport of the mechanically ventilated critically ill patient outside the ICU 1 1 0 2 D, I, C, M Domain 11: Patient safety and health systems management 11.1 Leads a daily multidisciplinary ward round 1 0 2 2 M 11.2 Complies with local infection control measures 3 3 3 3 C, M 11.3 Identifies environmental hazards and promotes safety for patients and staff 2 2 2 3 C, M 11.4 Identifies and minimises risk of critical incidents and adverse events, including complications of critical illness 1 1 1 2 C, M 11.5 Organises a case conference 0 0 0 2 C, M 11.6 Critically appraises and applies guidelines, protocols and care bundles 2 2 2 2 C 11.7 Describes commonly used scoring systems for assessment of severity of illness, case mix and workload 1 1 1 3 C 11.8 Demonstrates an understanding of the managerial and administrative responsibilities of the ICM specialist 0 0 0 2 C, M Domain 12: Professionalism 12.1 Communicates effectively with patients and relatives 2 2 2 3 D, M, T, S 12.2 Communicates effectively with members of the health care team 2 2 2 3 D, M, S 12.3 Maintains accurate and legible records / documentation 2 2 2 4 D, M, T 12.4 Involves patients (or their surrogates if applicable) in decisions about care and treatment 1 1 1 3 C, M, T 12.5 Demonstrates respect of cultural and religious beliefs and an awareness of their impact on decision making 2 2 2 4 C, M, T 12.6 Respects privacy, dignity, confidentiality and legal constraints on the use of patient data 2 2 2 4 C, M 12.7 Collaborates and consults; promotes team-working 2 2 2 3 M 12.8 Ensures continuity of care through effective hand- over of clinical information 2 2 2 4 C, M, T, S 12.9 Supports clinical staff outside the ICU to enable the delivery of effective care 2 2 2 3 C, M, T 12.10 Appropriately supervises, and delegates to others, the delivery of patient care 1 1 1 2 C, M, T 12.11 Takes responsibility for safe patient care 2 2 2 4 D, C, M, T II - 13

12.12 Formulates clinical decisions with respect for ethical and legal principles 1 1 1 2 C, M, T 12.13 Seeks learning opportunities and integrates new knowledge into clinical practice 2 2 2 4 M 12.14 Participates in multidisciplinary teaching 3 3 3 4 M 12.15 Participates in research or audit under supervision 2 2 2 3 M End of Year Meeting sign-off: (complete as applicable for number of years required in Stage 1 ST training copy and paste additional years if necessary) 1 Trainer Signature: Trainer Name (Print): Trainer GMC Number: Date (DD/MM/YYYY) (ICM Clinical Supervisor, ICM Educational Supervisor or FICM Tutor) Trainee Signature: Trainee Name (Print): Trainee GMC Number: Date (DD/MM/YYYY) Comments: 2 Trainer Signature: Trainer Name (Print): Trainer GMC Number: Date (DD/MM/YYYY) (ICM Clinical Supervisor, ICM Educational Supervisor or FICM Tutor) Trainee Signature: Trainee Name (Print): Trainee GMC Number: Date (DD/MM/YYYY) Comments: II - 14

INTENSIVE CARE MEDICINE STAGE 2 TRAINING RECORD Name of Trainee: Hospital(s): GMC Number: Date of Stage 2 entry: (DD/MM/YYYY) Instructions Number each assessment in your portfolio (e.g. for DOPS D1, D2 etc). Complete the table columns Trainee Evidence by identifying in the relevant item(s) of evidence in your portfolio by its code (D1, D2 etc). At least 1 piece of suitable evidence is required for each of the relevant competencies. One assessment can be used to cover multiple curriculum competencies. The WPBA column describes what type of workplacebased assessment is suitable for each competency, as defined by The CCT in Intensive Care Medicine. Other types of evidence may be used to demonstrate competencies, as described in Additional Assessment Tools Key below. Competencies may be signed off by Educational Supervisors throughout the training Stage. Please ensure that the numbering of evidence items in this table matches that in your portfolio. Stage 2 Target Level indicates the final competency level for this Stage of training. Trainees should not normally be marked higher than these levels at the end of this Stage unless in exceptional circumstances or if they have developed these competencies through additional training (for example a Special Skills year in Paediatric or Cardiac ICM). Entry from Stage 1 indicates the level at which the trainee entered Stage 2 from Stage 1. Please see the full Syllabus for details of the knowledge, skills and behaviours which make up each competency. Achievement Levels for some competencies may not change between training Stages these have been highlighted. In these instances Educational Supervisors must still sign-off each competency but trainees need not provide additional WPBA or assessment evidence if trainers are satisfied they have demonstrated maintenance of their skills and knowledge in these specific competencies. Further assessments in these competencies may be conducted if required, at the trainers discretion. Competency Level Descriptors Level Task orientated competence Knowledge orientated competence Patient management competence 1 Performs task under direct supervision. 2 3 Performs task in straightforward circumstances, requires help for more difficult situations. Understands indications and complications of task. Performs task in most circumstances, will need some guidance in complex situations. Can manage most complications, has a good understanding of contraindications and alternatives. Very limited knowledge; requires considerable guidance to solve a problem within the area. Sound basic knowledge; requires some guidance to solve a problem within the area. Will have knowledge of appropriate guidelines and protocols. Advanced knowledge and understanding; only requires occasional advice and assistance to solve a problem. Will be able to assess evidence critically. 4 Independent (consultant) practice. Expert level of knowledge. Specialist. Can take history, examine and arrange investigations for straight forward case (limited differential diagnosis). Can initiate emergency management and continue a management plan, recognising acute divergences from the plan. Will need help to deal with these. Can take history, examine and arrange investigations in a more complicated case. Can initiate emergency management. In a straightforward case, can plan management and manage any divergences in short term. Will need help with more complicated cases. Can take history, examine and arrange investigations in a more complex case in a focused manner. Can initiate emergency management. In a most cases, can plan management and manage any divergences. May need specialist help for some cases. Workplace-Based Assessment Tools Key D Direct Observation of Procedural Skills [DOPS] C Case-Based Discussion [CBD] T Acute Care Assessment Tool [ACAT] I ICM Mini-Clinical Evaluation Exercise [I-CEX] M Multi-source Feedback [MSF] S Simulation Additional Assessment Tools Key - These can be used in Trainee Evidence as appropriate for the competency being assessed L Anaesthetic List Management Tool [ALMAT] EE Educational Event G Logbook page [include page ref, i.e. G22] II - 15

Domain and Competencies Entry from Stage 1 Stage 2 Target Level Level Achieved Assessment Tools Domain 1: Resuscitation and management of the acutely ill patient 1.1 Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology 3 4 I, C, M, T, S 1.2 Manages cardiopulmonary resuscitation ALS recommended 3 4 I, M, T, S 1.3 Manages the patient post resuscitation 2 4 I, M, T, S 1.4 Triages and prioritises patients appropriately, including timely admission to ICU 2 3 C, M, T 1.5 Assesses and provides initial management of the trauma patient 2 3 D, I, M, T, C, S 1.6 Assesses and provides initial management of the patient with burns 1 2 D, I, M, T, C 1.7 Describes the management of mass casualties 1 2 C Domain 2: Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation 2.1 Obtains a history and performs an accurate clinical examination 3 4 I, M 2.2 Undertakes timely and appropriate investigations 3 3 I, C, M 2.3 Performs electrocardiography (ECG / EKG) and interprets the results 3 4 D, I, C 2.4 Obtains appropriate microbiological samples and interprets results 3 4 D, C 2.5 Obtains and interprets the results from blood gas samples 3 4 D, C 2.6 Interprets imaging studies 3 4 I, C 2.7 Monitors and responds to trends in physiological variables 3 4 I, T, S 2.8 Integrates clinical findings with laboratory investigations to form a differential diagnosis 2 3 I, C, T, S Domain 3: Disease Management 3.1 Manages the care of the critically ill patient with specific acute medical conditions 2 3 D, I, C, M, T, S 3.2 Identifies the implications of chronic and co-morbid disease in the acutely ill patient 2 3 C 3.3 Recognises and manages the patient with circulatory failure 2 3 I, C, T, S 3.4 Recognises and manages the patient with, or at risk of, acute renal failure 2 3 I, C, T 3.5 Recognises and manages the patient with, or at risk of, acute liver failure 2 3 I, C, T 3.6 Recognises and manages the patient with neurological impairment 2 3 I, C, T, S 3.7 Recognises and manages the patient with acute gastrointestinal failure 2 3 I, C, T 3.8 Recognises and manages the patient with severe acute respiratory failure / acute lung injury syndromes (ALI / ARDS) 2 3 I, C, T 3.9 Recognises and manages the septic patient 2 3 I, C, T 3.10 Recognises and manages the patient following intoxication with drugs or environmental toxins 2 3 I, C, S 3.11 Recognises life-threatening maternal peripartum complications and manages care 2 3 I, C, S Domain 4: Therapeutic interventions / Organ support in single or multiple organ failure 4. 1 Prescribes drugs and therapies safely 3 3 D, C, M 4.2 Manages antimicrobial drug therapy 3 3 I, C, M 4.3 Administers blood and blood products safely 3 4 D, C, M 4.4 Uses fluids and vasoactive / inotropic drugs to support the circulation 3 4 I, C 4.5 Describes the use of mechanical assist devices to support the circulation 1 2 C 4.6 Initiates, manages, and weans patients from invasive and non-invasive ventilatory support 2 4 D, C, T 4.7 Initiates, manages and weans patients from renal replacement therapy 2 3 D, I, C, T Trainee Evidence Educational Supervisor Sign-off Date II - 16

4.8 Recognises and manages electrolyte, glucose and acid-base disturbances 3 4 I, C, T, S 4.9 Co-ordinates and provides nutritional assessment and support 3 4 I, C, T Domain 5: Practical procedures 5.1 Administers oxygen using a variety of administration devices 3 4 D, S 5.2 Performs emergency airway management 2 3 D, S 5.3 Performs difficult and failed airway management according to local protocols 2 2 D, S 5.4 Performs endotracheal suction 3 4 D 5.5 Performs fibreoptic bronchoscopy and BAL in the intubated patient 2 3 D, M 5.6 Performs percutaneous tracheostomy 1 3 D, M, S 5.7 Performs chest drain insertion 2 3 D 5.8 Performs arterial catheterisation 3 4 D, C 5.9 Performs ultrasound techniques for vascular localisation 2 4 C 5.10 Performs central venous catheterisation 2 4 D, C 5.11 Performs defibrillation and cardioversion 3 4 D, C, S 5.12 Performs transthoracic cardiac pacing, describes transvenous 2 3 D, C 5.13 Describes how to perform pericardiocentesis 1 2 C 5.14 Demonstrates a method for measuring cardiac output and derived haemodynamic variables 3 4 D, C 5.15 Performs lumbar puncture (intradural / 'spinal') under supervision 3 4 D, S 5.16 Manages the administration of analgesia via an epidural catheter 3 4 I 5.17 Performs abdominal paracentesis 1 2 D 5.18 Describes Sengstaken tube (or equivalent) placement 2 2 C 5.19 Performs nasogastric tube placement 4 4 D 5.20 Performs urinary catheterisation 4 4 D Domain 6: Perioperative care 6.1 Manages the pre- and post-operative care of the high risk surgical patient 2 4 C, M, T 6.2 Manages the care of the patient following cardiac surgery 1 3 C 6.3 Manages the care of the patient following craniotomy 1 3 C, T 6.4 Manages the care of the patient following solid organ transplantation 1 3 C 6.5 Manages the pre- and post-operative care of the trauma patient under supervision 2 3 C. T Domain 7: Comfort and recovery 7.1 Identifies and attempts to minimise the physical and psychosocial consequences of critical illness for patients and families 3 4 M, C 7.2 Manages the assessment, prevention and treatment of pain and delirium 3 4 D, I, C, M, T 7.3 Manages sedation and neuromuscular blockade 2 4 D, I, C, M, T 7.4 Communicates the continuing care requirements, including rehabilitation, of patients at ICU discharge to health care professionals, patients and relatives 3 4 M, T, S 7.5 Manages the safe and timely discharge of patients from the ICU 2 3 M, T Domain 8: End of life care 8.1 Manages the process of withholding or withdrawing treatment with the multidisciplinary team 2 3 C, M 8.2 Discusses end of life care with patients and their families / surrogates 2 3 C, M, D 8.3 Manages palliative care of the critically ill patient 2 4 C, M, T II - 17

8.4 Performs brain-stem death testing 1 4 D, S 8.5 Manages the physiological support of the organ donor 1 3 I, C 8.6 Manages donation following cardiac death 1 3 C, T, S Domain 9: Paediatric care 9.1 Describes the recognition of the acutely ill child and initial management of paediatric emergencies 1 3 I, C, S 9.2 Describes national legislation and guidelines relating to child protection and their relevance to critical care 3 3 C Domain 10: Transport 10.1 Undertakes transport of the mechanically ventilated critically ill patient outside the ICU 2 4 D, I, C, M Domain 11: Patient safety and health systems management 11.1 Leads a daily multidisciplinary ward round 2 3 M 11.2 Complies with local infection control measures 3 4 C, M 11.3 Identifies environmental hazards and promotes safety for patients and staff 3 4 C, M 11.4 Identifies and minimises risk of critical incidents and adverse events, including complications of critical illness 2 3 C, M 11.5 Organises a case conference 2 3 C, M 11.6 Critically appraises and applies guidelines, protocols and care bundles 2 3 C 11.7 Describes commonly used scoring systems for assessment of severity of illness, case mix and workload 3 4 C 11.8 Demonstrates an understanding of the managerial and administrative responsibilities of the ICM specialist 2 3 C, M Domain 12: Professionalism 12.1 Communicates effectively with patients and relatives 3 4 D, M, T, S 12.2 Communicates effectively with members of the health care team 3 4 D, M, S 12.3 Maintains accurate and legible records / documentation 4 4 D, M, T 12.4 Involves patients (or their surrogates if applicable) in decisions about care and treatment 3 4 C, M, T 12.5 Demonstrates respect of cultural and religious beliefs and an awareness of their impact on decision making 4 4 C, M, T 12.6 Respects privacy, dignity, confidentiality and legal constraints on the use of patient data 4 4 C, M 12.7 Collaborates and consults; promotes team-working 3 4 M 12.8 Ensures continuity of care through effective hand- over of clinical information 4 4 C, M, T, S 12.9 Supports clinical staff outside the ICU to enable the delivery of effective care 3 4 C, M, T 12.10 Appropriately supervises, and delegates to others, the delivery of patient care 2 3 C, M, T 12.11 Takes responsibility for safe patient care 4 4 D, C, M, T 12.12 Formulates clinical decisions with respect for ethical and legal principles 2 3 C, M, T 12.13 Seeks learning opportunities and integrates new knowledge into clinical practice 4 4 M 12.14 Participates in multidisciplinary teaching 4 4 M 12.15 Participates in research or audit under supervision 3 4 M II - 18

End of Year Meeting sign-off: (complete as applicable for number of years required in Stage 2 training copy and paste additional years if necessary) 1 Trainer Signature: Trainer Name (Print): Trainer GMC Number: Date (DD/MM/YYYY) (ICM Clinical Supervisor, ICM Educational Supervisor or FICM Tutor) Trainee Signature: Trainee Name (Print): Trainee GMC Number: Date (DD/MM/YYYY) Comments: 2 Trainer Signature: Trainer Name (Print): Trainer GMC Number: Date (DD/MM/YYYY) (ICM Clinical Supervisor, ICM Educational Supervisor or FICM Tutor) Trainee Signature: Trainee Name (Print): Trainee GMC Number: Date (DD/MM/YYYY) Comments: II - 19

INTENSIVE CARE MEDICINE STAGE 3 TRAINING RECORD Name of Trainee: Hospital(s): GMC Number: Date of Stage 3 entry: (DD/MM/YYYY) Instructions Number each assessment in your portfolio (e.g. for DOPS D1, D2 etc). Complete the table columns Trainee Evidence by identifying in the relevant item(s) of evidence in your portfolio by its code (D1, D2 etc). At least 1 piece of suitable evidence is required for each of the relevant competencies. One assessment can be used to cover multiple curriculum competencies. The WPBA column describes what type of workplacebased assessment is suitable for each competency, as defined by The CCT in Intensive Care Medicine. Other types of evidence may be used to demonstrate competencies, as described in Additional Assessment Tools Key below. Competencies may be signed off by Educational Supervisors throughout the training Stage. Please ensure that the numbering of evidence items in this table matches that in your portfolio. Stage 2 Target Level indicates the final competency level for this Stage of training. Trainees should not normally be marked higher than these levels at the end of this Stage unless in exceptional circumstances or if they have developed these competencies through additional training (for example a Special Skills year in Paediatric or Cardiac ICM). Entry from Stage 2 indicates the level at which the trainee will have entered Stage 3 from Stage 2. Please see the full Syllabus for details of the knowledge, skills and behaviours which make up each competency. Achievement Levels for some competencies may not change between training Stages these have been highlighted. In these instances Educational Supervisors must still sign-off each competency but trainees need not provide additional WPBA or assessment evidence if trainers are satisfied they have demonstrated maintenance of their skills and knowledge in these specific competencies. Further assessments in these competencies may be conducted if required, at the trainers discretion. Competency Level Descriptors Level Task orientated competence Knowledge orientated competence Patient management competence 1 Performs task under direct supervision. 2 3 Performs task in straightforward circumstances, requires help for more difficult situations. Understands indications and complications of task. Performs task in most circumstances, will need some guidance in complex situations. Can manage most complications, has a good understanding of contraindications and alternatives. Very limited knowledge; requires considerable guidance to solve a problem within the area. Sound basic knowledge; requires some guidance to solve a problem within the area. Will have knowledge of appropriate guidelines and protocols. Advanced knowledge and understanding; only requires occasional advice and assistance to solve a problem. Will be able to assess evidence critically. 4 Independent (consultant) practice. Expert level of knowledge. Specialist. Can take history, examine and arrange investigations for straight forward case (limited differential diagnosis). Can initiate emergency management and continue a management plan, recognising acute divergences from the plan. Will need help to deal with these. Can take history, examine and arrange investigations in a more complicated case. Can initiate emergency management. In a straightforward case, can plan management and manage any divergences in short term. Will need help with more complicated cases. Can take history, examine and arrange investigations in a more complex case in a focused manner. Can initiate emergency management. In a most cases, can plan management and manage any divergences. May need specialist help for some cases. Workplace-Based Assessment Tools Key D Direct Observation of Procedural Skills [DOPS] C Case-Based Discussion [CBD] T Acute Care Assessment Tool [ACAT] I ICM Mini-Clinical Evaluation Exercise [I-CEX] M Multi-source Feedback [MSF] S Simulation Additional Assessment Tools Key - These can be used in Trainee Evidence as appropriate for the competency being assessed L Anaesthetic List Management Tool [ALMAT] EE Educational Event G Logbook page [include page ref, i.e. G22] II - 20